Digesting the hundreds of pages in the MPFS 2017 Final Rule is best done in small bites. Here are five tidbits to get you started.
1. The Conversion Factor Goes Up a Little
The 2017 conversion factor is just a bit bigger than the 2016 conversion factor:
- 2016: 35.8043
- 2017: 35.8887.
Read about it: You’ll find the conversion factor listed on page 374 of the Final Rule PDF.
2. Non-F2F Prolonged Services Get Some Respect
In a change from 2016, Medicare will offer separate payment for prolonged services codes 99358 (Prolonged evaluation and management service before and/or after direct patient care; first hour) and +99359 (… each additional 30 minutes [List separately in addition to code for prolonged service]).
Caution: Do not count time more than once. If the time is included in another MPFS service you’re reporting, don’t report the prolonged service codes, too.
Read about it: The MPFS offers insights into proper use of these codes on page 59 of the Final Rule PDF.
3. CMS Has a List of 0-Day Global Codes & Is Checking It Twice for Mod 25
Codes with 0-, 10-, and 90-day global periods include reimbursement for E/M services routinely provided with the service or procedure. CMS has been seeing certain codes with 0-day global periods billed frequently (half of the time or more) with E/M codes. Because the E/M codes have modifier 25 (Significant, separately identifiable E/M service on the same day…) appended, they get separate reimbursement. Medicare wants to be sure those service and procedure codes often paired with an E/M are properly valued. The proposed rule listed 83 codes to check. The final rule shortens the list significantly.
Read about it: Check out Table 8 on page 37 of the Final Rule PDF.
Bonus tip: Discussion of data collection requirements for 10-day and 90-day global periods starts on p. 40 of the Final Rule PDF.
4. HCPCS Is the Home of Telehealth Consult Codes
Medicare created G0508 (Telehealth consultation, critical care, physicians typically spend 60 minutes communicating with the patient and providers via telehealth [initial]) and G0509 (Telehealth consultation, critical care, physicians typically spend 50 minutes communicating with the patient and providers via telehealth [subsequent]).
The codes allow you to report telehealth services for critical care, such as in the case of stroke.
Read about it: Discussion of these codes starts on p. 183 of the Final Rule PDF.
5. Programs Like MDPP Put Primary Care in the Spotlight
The Final Rule confirms an expansion of the duration and scope of the Medicare Diabetes Prevention Program (MDPP). The goal of the program is to prevent type 2 diabetes in beneficiaries with pre-diabetes. Prevention has been seen as a way to keep patients healthier and reduce Medicare expenses.
Read about it: Get comfortable, and dig into the long discussion starting on p. 290 of the Final Rule PDF.
What Do You Think?
Do you review the MPFS Final Rule, or do you tend to focus on day-to-day MPFS data for codes, like global periods and allowed modifiers?